Provider Demographics
NPI:1750699617
Name:MARTINEZ, JORGE HUGO JR (AUD)
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:HUGO
Last Name:MARTINEZ
Suffix:JR
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 N CAUSEWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-3104
Mailing Address - Country:US
Mailing Address - Phone:985-327-5905
Mailing Address - Fax:205-623-1080
Practice Address - Street 1:1420 N CAUSEWAY BLVD
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-3104
Practice Address - Country:US
Practice Address - Phone:985-327-5905
Practice Address - Fax:205-623-1080
Is Sole Proprietor?:No
Enumeration Date:2010-09-14
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6328231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2137476Medicaid
LA2137476Medicaid